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Query: UMLS:C0000727 (acute abdomen)
 3,084 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three children presented as acute surgical emergencies due to undiagnosed diabetes mellitus. Where diabetic ketoacidosis mimicks the acute abdomen three clinical features are important in reaching the right diagnosis-namely, a history of polydipsia, polyuria, and anorexia preceding the abdominal pain, the deep sighing and rapid respirations, and severe dehydration.
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PMID:Acute diabetic abdomen in childhood. 5 84

Primary torsion of the omentum is an unusual cause of an acute abdomen and commonly mimics acute appendicitis. The following report of four obese children is supportive of obesity as a predisposing factor. The paucity of gastrointestinal symptoms, anorexia, nausea, vomiting, and the relatively long duration of symptoms, may increase the index of suspicion. In the majority of cases, the diagnosis is made intraoperatively by digital exploration through the muscle-splitting incision. The torsed omentum is easily delivered through the same incision, and excision results in complete recovery.
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PMID:Primary omental torsion in children. 766 14

A 20 year old woman with anorexia nervosa and severe weight loss developed extensive necrotizing colitis after being admitted to hospital for stabilization of her weight. Necrotizing colitis with anorexia nervosa has been reported previously. We report a second case. We believe necrotizing colitis is a true complication of anorexia nervosa and should be considered in the differential diagnosis in patients with primary anorexia who develop an acute abdomen.
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PMID:Anorexia nervosa and necrotizing colitis: case report and review of the literature. 801 11

There are three clinical presentations of anthrax in humans: cutaneous (>95% of cases), orogastric and inhalational. The infectious form, the spore, enters the body and is thought to germinate within macrophages either at the site of inoculation (cutaneous or orogastric) or in the regional lymph node (inhalational). The bacillus then synthesizes its antiphagocytic capsule and the lethal and oedema toxins which interfere with the non-specific host defences leading to the characteristic locally destructive lesion and spread by lymphatics to the systemic circulation and other organs. The cutaneous form begins as a papule which progresses over several days to a vesicle and then ulcerates. There is often oedema, sometimes massive, probably due to the oedema toxin that surrounds the lesions which then develop a characteristic black eschar. The patient may be febrile with mild to severe systemic symptoms of malaise, headache and toxicity. Oropharyngeal anthrax presents with severe sore throat or an ulcer in the oropharyngeal cavity associated with neck swelling, fever, toxicity and dysphagia. Gastrointestinal anthrax begins with anorexia, nausea, vomiting and abdominal pain which may be similar to an acute abdomen. There may be diarrhoea and ascites, both of which may be haemorrhagic. Inhalational anthrax begins with non-specific symptoms of malaise, fever, myalgia and non-productive cough. After a period of 2-3 days, this is followed by a sudden onset of severe respiratory distress associated with diaphoresis, cyanosis and increased chest pain. There may be a widened mediastinum and pleural effusions on chest X-ray. Death follows in 24-36 h from respiratory failure, sepsis and shock. The diagnosis of anthrax is easy if it is considered. The organism is readily observed by Gram or Wright stain in local lesions or blood smear and can be easily cultured from the blood and other body fluids. However, because of its rarity, it is not often included in the differential diagnosis and in inhalational disease the diagnosis is rarely made until the patient is moribund. More rapid diagnostic tests are under development. Penicillin, combined with supportive care, remains the mainstay of treatment, although the organism is susceptible in vitro to many antibiotics. In recent years, there have been significant advances in our knowledge of the organism and its toxins and it is anticipated that similar progress will be made in the future in developing more rapid diagnostic tests and new modalities of treatment.
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PMID:Clinical aspects, diagnosis and treatment of anthrax 1047 74

A report is presented of a 48-year-old gay man, HIV-positive for 7 years, who came to the emergency room due to six hours of abdominal pain accompanied by anorexia, nausea, and dry heaves. Initial examination and laboratory tests showed nonspecific bowel gas, and the patient was discharged with instructions to use an enema at home for constipation. After worsening of symptoms, a private physician diagnosed acute abdomen with surgical consultation. A jejunal perforation secondary to B-cell Hodgkin's lymphoma was diagnosed and the patient was treated with low-dose CHOP (cytoxan, adriamycin, vincristine, and prednisone) for four cycles and had his antiretroviral regimen changed.
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PMID:Acute abdomen in an HIV-positive man. 1136 99

A 64-year-old man with treated hypothyroidism had 10 months of diarrhea, abdominal pain, anorexia and recent involuntary 13.6 kg weight loss. He presented to hospital with an acute abdomen that had a radiological correlate of free air under the diaphragm. He was diagnosed with a perforated mid-jejunum due to an ulcerated enteropathy-type T cell lymphoma (ETL), complicating collagenous sprue and cryptic celiac disease. Polymerase chain reaction verified monoclonal gamma- and beta-T cell receptor gene rearrangements in the neoplasm. He had a complete resolution of symptoms when treated with a gluten-free diet in the postoperative period. This is apparently the first report describing collagenous sprue and ETL as synchronous lesions. Because atypical CD8+ lymphocytes are in both the collagenous sprue epithelium and ETL, the implication is that collagenous sprue is a noninvasive component of the ETL.
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PMID:Synchronous collagenous sprue and enteropathy-type T cell lymphoma: variants of the same disease. 1515 84

A perforation of Meckel's diverticulum by foreign bodies is an extremely rare cause of acute abdomen in adults. We herein present a case of a 30-year-old man who was admitted due to symptoms of right lower quadrant pain, anorexia, and vomiting. An exploratory laparotomy was done, and a perforated Meckel's diverticulum due to a chicken bone was found at exploration. A resection of a segment of ileum including the perforated diverticulum was performed, and the patient had an uncomplicated postoperative course.
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PMID:Perforation of Meckel's diverticulum by a chicken bone, a rare complication: report of a case. 1522 56

Abdominal tuberculosis (TB) is a rare manifestation, which can be overlooked on long-lasting and non-specific findings unless a high index of suspicion is maintained. The purpose of the present study was to investigate the diagnostic features of 39 patients hospitalized with tuberculous peritonitis (TBP) in Dicle University Hospital, Turkey between January 1994 and August 2003. Twenty-two patients were male; patient age ranged between 1 and 59 years (mean: 16.2 +/- 14.4 years). There were 21 patients (54%) under 15 years of age. Thirteen children had a history of familial TB and seven adults had prior history of TB. Six (29%) of 21 pediatric cases had bacille Calmette-Guerin (BCG) scars and results of 5-tuberculin units (TU) tuberculin test were positive in seven children (18%). Of all cases, the most common presenting findings were abdominal pain (95%), ascites (92%) and abdominal distention (82%). Five of the patients had accompanying pulmonary TB, and six patients (15%) had intestinal TB who were admitted to emergency service with acute abdomen, of whom three (8%) had perforation and three (8%) had ileus. Histopathologically 20 cases (51%) were proven on abdominal ultrasonography, and computed tomography revealed most commonly ascites and thickening of peritoneum. No microbiologic evidence was obtained except three positive culture results for Mycobacterium tuberculosis. As a result, TBP should be considered for diagnosis, in patients with non-specific symptoms of abdominal pain, wasting, fever, loss of appetite, abdominal distension and even symptoms of acute abdomen, because early diagnosis and effective treatment will decrease morbidity and mortality.
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PMID:Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey. 1707 36

Clostridium myonecrosis is a rare and deadly infection that progresses very rapidly; thus, prompt diagnosis and treatment is vital. In adults, clostridial myonecrosis used to be a well-known complication of war wounds. Today, it is usually seen in settings of trauma, surgery, malignancy, skin infections/burns, and septic abortions. More recently, cases of nontraumatic or spontaneous clostridial myonecrosis have been reported in both adults and children. Clostridium perfringens and Clostridium septicum are responsible for the majority of the clinically relevant infections. Higher mortality rates are seen when C septicum is the causative agent. Here we present a child who survived a severe case of C septicum myonecrosis involving both abdominal and thoracic cavities. This rare infection has a high mortality rate and might be easily misdiagnosed in children, even by experienced clinicians, because of its nonspecific presentation. We also review all reported pediatric cases of C septicum infection and myonecrosis and discuss the surgical and medical interventions associated with improved survival. We identified a total of 47 cases of C septicum infection; of these, 22 (47%) were cases of C septicum associated with myonecrosis. Several factors, if available, were analyzed for each case: age, gender, infection location, previous diagnoses, presenting signs and symptoms, neutropenia, gross pathology of the colon, antibiotic use, surgical intervention, and final outcome. We found that conditions related with C septicum infection in children can be grouped into 3 major categories: patients with neutrophil dysfunction; patients with associated bowel ischemia; and patients with a history of trauma. Malignancies were found in 49% of the cases, cyclic or congenital neutropenia in 21%, hemolytic-uremic syndrome in 11%, structural bowel ischemia in 4%, and local extremity trauma in 6%. In addition, 6% of the cases had no known underlying disorder. Abdominal symptoms including vomiting, diarrhea, blood per rectum, abdominal pain, anorexia, and/or acute abdomen, were reported in 85% of the children. Fever was also a common finding. The mainstay of treatment for C septicum infection was parenteral antibiotics and/or surgical intervention. The mortality rate for children with C septicum infection and myonecrosis was 57% and 59%, respectively. Although 82% of all cases received antibiotics, only 43% underwent therapeutic surgical intervention. Several clinical factors were found to be associated with improved survival. Only 35% of the children with gastrointestinal tract involvement survived, compared with 86% of the children without gastrointestinal tract involvement. The survival rates for other conditions ranged from 0% to 50%. One hundred percent survival was reported in patients with no previously diagnosed conditions and those with infections resulting from trauma to the extremities. All survivors received antibiotic treatment, compared with only 68% of the nonsurvivors. Most survivors (84%) underwent therapeutic surgical intervention, compared with only 12% of nonsurvivors. Other treatments were used adjunctively, including hyperbaric oxygen, granulocyte colony-stimulating factor, granulocyte transfusions, and intravenous immunoglobulin. C septicum infections in children are often fatal; thus, one needs to have a high index of suspicion in at-risk patients. This review describes who these patients are, their clinical presentation, and the therapeutic strategies associated with improved survival.
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PMID:Clostridium septicum infections in children: a case report and review of the literature. 1656 92

A case of acute abdomen due to diastasic perforation of the right colon by volvulus on mesenterium commune with associated agenesis of the left kidney and urogenital malformations in a young woman is reported. The case emphasizes the complexity and the polymorphism of congenital abdominal malformations, particularly predisposing to volvulus, that can represent a really challenge for emergency surgeon. The A.A. analyze literature about congenital intestinal anomalies to evaluate clinical, diagnostic and therapeutical problems, and they remark features to take into consideration in emergency: clinical history in non-operated patient of abdominal pain and biliary vomit with spontaneous resolutions; nutritional compromise; hypothetical diagnosis of anorexia or food intolerance; malformations in other organs or systems and, one mostly, young age. The correct interpretation of these symptoms can suggest suspicious of an occlusive complication due to intestinal malformations. Radiological data and the exploratory laparotomy or laparoscopy will confirm our intuition. If otherwise diagnosis of the cause underlying the chronic recurrent abdominal pain are delayed, surgical operation in emergency condition will be more aggressive and anatomical structures sacrificed.
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PMID:[Congenital intestinal malformations: clinical evaluation and specific treatment. Case report and literature review]. 1713 43


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